Factors associated with the utilization and costs of health and social services in frail elderly patients

Research Department, Social Insurance Institution of Finland, Helsinki, Finland.
BMC Health Services Research (Impact Factor: 1.71). 07/2012; 12(1):204. DOI: 10.1186/1472-6963-12-204
Source: PubMed


Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients.
Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization.
The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure.
The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in the long run, result in increased costs of health care.

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Available from: Katariina Hinkka, Oct 04, 2015
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    • "This study did not find significant differences in older people's service use between the two cities (Tampere and Jyv€ askyl€ a), though a previous study has observed variations in service provisions and use between different municipalities in Finland (e.g. Kehusmaa et al. 2012). The findings of this paper cannot be expected to reveal the national situation because the sample population represents only two cities in Finland. "
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    ABSTRACT: Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N = 1436). The methods of analysis used include cross-tabulation, chi-square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n = 681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two-tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services. © 2015 John Wiley & Sons Ltd.
    Health & Social Care in the Community 04/2015; DOI:10.1111/hsc.12245 · 1.15 Impact Factor
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    • "Similarly, counties with higher costs for elderly care are correlated with counties with lower rates of seniors fall (Andersen 2008; Kehusmaa et al. 2012; Landi et al. 2001; Sandberg et al. 2012). Burnett (2005), Bleijlevens et al. (2010), and Giuliano et al. (2003) related accessibility to services with elderly fall. "
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    • "An earlier study of ours has shown that FIM is associated with social care service use, and HRQoL 15D appears to be a powerful indicator for the utilization of health care services [27]. Based on this prior knowledge, in Model 3, public care expenditure was controlled for independent disability level (FIM) and health-related quality of life (HRQoL 15D) [27]. These results show that FIM, HRQoL15D and Care Pattern are associated with expenditure (Model 3). "
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    ABSTRACT: To formulate sustainable long-term care policies, it is critical first to understand the relationship between informal care and formal care expenditure. The aim of this paper is to examine to what extent informal care reduces public expenditure on elderly care. Data from a geriatric rehabilitation program conducted in Finland (Age Study, n = 732) were used to estimate the annual public care expenditure on elderly care. We first constructed hierarchical multilevel regression models to determine the factors associated with elderly care expenditure. Second, we calculated the adjusted mean costs of care in four care patterns: 1) informal care only for elderly living alone; 2) informal care only from a co-resident family member; 3) a combination of formal and informal care; and 4) formal care only. We included functional independence and health-related quality of life (15D score) measures into our models. This method standardizes the care needs of a heterogeneous subject group and enabled us to compare expenditure among various care categories even when differences were observed in the subjects' physical health. Elder care that consisted of formal care only had the highest expenditure at 25,300 Euros annually. The combination of formal and informal care had an annual expenditure of 22,300 Euros. If a person received mainly informal care from a co-resident family member, then the annual expenditure was only 4,900 Euros and just 6,000 Euros for a person living alone and receiving informal care. Our analysis of a frail elderly Finnish population shows that the availability of informal care considerably reduces public care expenditure. Therefore, informal care should be taken into account when formulating policies for long-term care. The process whereby families choose to provide care for their elderly relatives has a significant impact on long-term care expenditure.
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